Implementing innovative solutions for effective referral for critical maternal and newborn health conditions in Ethiopia

To reduce maternal and newborn mortality rates in the country the government of Ethiopia (GoE) is mobilizing communities to promote skilled delivery; promoting referral linkages between communities and health facilities; providing ambulances; and ensuring basic emergency obstetric and newborn care (BEmONC) in primary health facilities. However, these initiatives may not necessarily lead to effective referrals if they are not well coordinated. As such, the Last Ten Kilometers project is working with the GoE in eight districts to demonstrate innovative solutions for effective referral for critical maternal and newborn health conditions. To facilitate the spread of effective referral solutions across the country the intervention will demonstrate vital functional elements of effective and efficient management of referrals from community to primary or higher health facilities.

In each intervention district an assessment was conducted using facility assessments, in-depth interviews, and focus group discussions to understand the local context and available referral resources based on the capacity of the health system and the needs of the population together with key health system and community stakeholders to identify gaps. The findings of the assessment was presented at a workshop with the referral stakeholders of the district (identified during the assessment) as the participants to validate the findings and use that information in the participatory design of innovations to strengthen the referral system involving demand and supply sides. This paper presents the major findings from the assessments and describes the innovative referral solutions that the districts and the local community have committed to actively manage.